Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0208X | Pediatric Infectious Diseases | 01063950 | IN |
NPI | 1376654996 |
---|---|
Provider Name | Dr. Benjamin F Weston |
First Address | Indianapolis, IN 46290-1024 |
Second Address | Kokomo, IN 46901-6460 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 16/12/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1376654996 | (05) | MI |
200867400 | (05) | IN |